Role of tumor necrosis factor a and nitric oxide in Development of renal impairment in spontaneous Bacterial peritonitis patients

Spontaneous bacterial peritonitis (SBP) is one of the most common complications attending the ascites in patients with liver cirrhosis, with a prevalence of 10-27%. It is particularly frequent in severely decompensated liver cirrhosis. In most cases, the complication develops after the patients are admitted to hospital. These patients are more likely to have gastrointestinal bleeding, encephalopathy and renal failure Hepatorenal syndrome (HRS) is a frequent event in the course of spontaneous bacterial peritonitis. Two different types of HRS have been defined, type I HRS characterized by rapid, progressive impairment of renal function in less than 2 weeks, it develops in 15% of ascitic cirrhotic patients during or after an episode of SBP, type II HRS is characterized by stable, moderate reduction of glomerular filtration rate (GFR) over weeks or months, the main clinical consequence of this type is diuretic resistance ascites. Hepatorenal syndrome constitutes the most important predictor of hospital mortality in SBP patients as half of patients with SBP complicated with hepatorenal syndrome die during hospitalization compared with 15% mortality in patients with SBP without functional renal failure. This work was carried out in Tropical Medicine and Biochemistry Departments, Zagazig University Hospitals during the period from January 2004 to June 2006